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,, r-rt MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> fjHf?f71? Salem,OR 97305 <br /> County 503-588-5147 <br /> Authorization NA FAX: 503-588-7948 <br /> OR:EG: O N <br /> 555-22-010189-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: ALAGOZ, SERGY <br /> 13039 BETHLEHEM DR NE <br /> GERVAIS, OR 97026 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: AUTH W/FL REPL 3 BDRM RES WITH NSFD 2 BDRM/OFFICE <br /> v m �,_. ...,N__ ,._, .r,.4.w,�,k .. <.,.__. __.> .. �. , s... <br /> ' ���..�r � �, t,; ��A STTI�INFO R[+IATIt3P1�a z"���s5 .�� d� '��i �� a «t sr � �« <br /> Property Address: Parcel: Owner: ALAGOZ,SERGY <br /> 13039 Bethlehem Dr Ne,Gervais,OR 97026 051W30ACO2200-Primary <br /> Address: 13039 BETHLEHEM DR NE <br /> GERVAIS OR 97026 <br /> _.,,,. . LICENSED PROFESSIONAL INFO "MATIOPfft � � g <br /> Business Name License Address Phone <br /> SEE PROPERTY OWNER INFORMATION Owner OWNER <br /> (Property <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $605.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $705.00 <br /> Note:This may not include all the fees required for this project. <br /> This application will expire if application acceptance cannot be achieved within 180 days. <br /> All provisions of laws and ordinances governing this type of work will be complied with <br /> whether specified herein or not. <br /> All persons or entities performing work under this application are required to be licensed <br /> unless exempted by ORS 701.010. <br /> Printed on: 11/07/2022 1 std_BuildingApplication_pr <br />